Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department

Publication Date: September 1, 2015
Last Updated: March 14, 2022

Recommendations

Patient Management

With a goal to improve functional outcomes, IV tPA should be offered and may be given to selected patients with acute ischemic stroke within 3 hours after symptom onset at institutions where systems are in place to safely administer the medication. The increased risk of symptomatic intracerebral hemorrhage (sICH) should be considered when deciding whether to administer IV tPA to patients with acute ischemic stroke. (B)
325320
When feasible, shared decisionmaking between the patient (and/or his or her surrogate) and a member of the health care team should include a discussion of potential benefits and harms prior to the decision whether to administer IV tPA for acute ischemic stroke. (C)
(Consensus recommendation)
325320
When feasible, shared decisionmaking between the patient (and/or his or her surrogate) and a member of the health care team should include a discussion of potential benefits and harms prior to the decision whether to administer IV tPA for acute ischemic stroke. (C)
(Consensus recommendation)
325320
Despite the known risk of sICH and the variability in the degree of benefit in functional outcomes, IV tPA may be offered and may be given to carefully selected patients with acute ischemic stroke within 3 to 4.5 hours after symptom onset at institutions where systems are in place to safely administer the medication. (B)
325320

Overview

Title

Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department

Authoring Organization

American College of Emergency Physicians